<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Origin_loginmobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-origin_loginmobile" data-rule="required" class="form-control" name="row[origin_loginmobile]" type="text" value="{$row.origin_loginmobile|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Issue_reason')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-issue_reason" data-rule="required" class="form-control" name="row[issue_reason]" type="text" value="{$row.issue_reason|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Current_contactinfo')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-current_contactinfo" data-rule="required" class="form-control" name="row[current_contactinfo]" type="text" value="{$row.current_contactinfo|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Has_dealed')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-has_dealed" data-rule="required" class="form-control selectpicker" name="row[has_dealed]">
                {foreach name="hasDealedList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.has_dealed"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Note')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-note" class="form-control" name="row[note]" type="text" value="{$row.note|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
